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General NPI Number Information
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NPI Number | 1114977410
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Entity Type | Organization
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Legal Business Name | ST. JUDE HEALTH CARE, INC.
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 12/31/2009
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Provider Practice Location Address
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Address Line | 6356 MANOR LANE SUITE 101
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City | SOUTH MIAMI
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State | FL
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Zip | 33143
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Country | US
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Telephone | 786-268-7812
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Fax | 786-268-7813
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Provider Business Mailing Address
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Address Line | 6356 MANOR LANE SUITE 101
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City | SOUTH MIAMI
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State | FL
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Zip | 33143
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Country | US
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Telephone | 786-268-7812
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Fax | 786-268-7813
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Authorized Official
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Title or Position | PRESIDENT
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Name | IRENE DEL ROSARIO TRUJILLO
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Credential | L.P.N.
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Telephone | 786-268-7812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 299992322
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License Number State | FL
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